This disparity led Maryland eCare to create a program that virtually connects critical care nurses, physicians and patients 24 hours a day.

Maryland eCare is a unique collaboration of independent hospitals working to improve patient care and safety for the communities they serve by sharing resources and bringing skilled critical care to rural Maryland.

Starting in May 2009, Maryland intensive care patients at Calvert Memorial Hospital in Prince Frederick, Maryland, have been connected by voice, video and data lines to specialized physicians and nurses at a tertiary care referral center 130 miles away. Maryland eCare’s remote monitoring center is based at Christiana Care Health System in Wilmington, Delaware.

“Critical care is delivered in hospitals throughout the nation, big and small, rural and urban and they all have different resources and processes,” said Anita Witzke, RN, MSN, eCare operations director. “ICU patient conditions can change very quickly and this system provides enhanced patient safety and improves care.”

Maryland eCare uses VISICU’s eICU solution, including the eCareManager System. The system provides instant voice, camera, and data links between the bedside and the critical care specialists miles away.

“A typical situation might be an ICU nurse that is hanging multiple IVs and cannot simultaneously reach a computer; the nurse would touch a button and be in immediate voice and video contact with a critical care expert,” explained Witzke. “The combination of medications as well as speed could be verified while the nurse is physically completing the task.”

“The cameras are not on all the time,” notes Witzke. “The on-site staff can start the camera and if the remote team wants to view the room, a doorbell sound is generated so that patients, visitors and staff know that the camera is now on.”

Nurses are more confident in their decisions, knowing they have immediate access to experts and can get second opinions on what they are seeing. “In the middle of the night, no nurse now needs to weigh the decision of waking the physician or not,” said Witzke. “For 12 hours, starting at 7 p.m., there is a critical care physician available.”

In addition to immediate access to critical care experts, the system provides real-time monitoring by the eCare nurses. “We have access to nursing assessments, vital signs, I/O, and the electronic medical record if one is in use,” explained Witzke. “The vital sign data is routed through a computer that detects trends and alerts us with moderate and significant changes.” These tools allow the remote staff to alert and work cohesively with on-site staff.

The communication and data are complemented by evidenced-based medicine protocols. “The protocols promote better medicine and safety and can be shared with hospitals that do not yet have access to them,” noted Witzke.

The eCare nurses each have more than five years of experience in a critical care setting. “Working as a general practitioner has renewed the enthusiasm of these nurses, even giving a second career options to those that can no longer keep up with the physical demand of bedside nursing,” explained Witzke.

Maryland eCare has one hospital “live” and five others in the implementation process. Christiana Care Health System supports its own two hospitals as well as the Maryland hospitals.

Witzke summarized, “eICU promotes a collaborative patient care partnership to meet the needs of patients, nurses, physicians and the mission of the hospital while enhancing critical care medicine.”